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Institutions are widely recognized as playing an important role in the transition from pre-modern to modern society. Hospitals are no exception. They have been used as a locus to trace themes as diverse as the professionalization of medicine, advances in science, state intervention and control, social reform, gender relations, and changed mentalities. Furthermore, institutions are expected to have origins. Things that are influential, that have an impact, are thought to come "from" somewhere. The issue of origins is alluded to by the authors of at the very beginning of The English Hospital. Prior to the publication of this book, the authors tell us, the most recent detailed survey of the medieval origins of English hospitals was published in 1909 (xi). How could this be? There are, of course, a number of ways to answer this question. As the historical profession has moved away from linear tales of growth and achievement, the need for histories of the medieval origins of modern institutions has become less self-evident. The authors of this book, however, do not face this issue straight on. Rather they attribute the long hiatus to difficulty of recovering suitable primary sources (xi). Little has been written because it was thought little could be known. The solution, they suggest, is an overview based on local studies. The book is divided into two sections, the first eight chapters being a general account, the final three a regional study of hospitals in the south-west of England. The eight-chapter narrative (written by Nicholas Orme) is readable and balanced and contains a number of corrective views. Against the idea of a "deserving poor" as a Protestant innovation, Orme suggests "from the first people approved of some poor, disapproved of others." (57) Women played a role both as providers and as recipients of hospital charity (82-3, 109). Some hospitals were involved in the education of boys and young adults (65). Larger institutions suffered during the dissolution of the monasteries in the mid-sixteenth century, but there were also efforts by the crown, particularly the Marian and Elizabethan regimes, to protect those institutions that did actually provide care for the sick. (165-6) There is also an interesting assessment of the importance of the physical location of hospitals. Pushed out of towns they often located themselves at bridges or crossroads so inmates could approach passers-by in the hope of increasing operating funds. (48) The second section written by both Orme and Webster (and presumably a summary of the latter's master's thesis), is far less readable. A brief overview of the findings written by Orme concludes with the rather bland assertion that "the history of hospitals in the South West reflected what was happening elsewhere in England, though not always so quickly or to the same extent." (185) This is followed by a series of brief histories that make for disjointed reading. While the first eight chapters appear to have been written for a general audience (we are reminded, for example, that "Edward VI was Protestant in religion" (160)), the final 80 pages are of interest only to specialists and local historians. One of the most striking findings of the book is evidence the authors have assembled that illustrates the variety and flexibility of these medieval institutions. "It is important to realize," Orme points out, "that contemporaries did not conceive of hospitals as a uniform group or describe them by a single common term." The authors found overlapping use of the terms "church," "college," "hospital" and "almshouse" (40-41). Some were established to care for lepers and the long-term infirm while others functioned primarily to offer food and lodging to the poorer sort of travelers. Pregnant poor women were another group that could receive help. In addition to providing food and shelter, most functioned as houses of worship. Moreover the functions of a particular institution were not fixed over time, but changed in response to local and national reform efforts and the desires of patrons. Unfortunately this book is as remarkable for what it has left out, as what it includes. Given the varied characteristics of the group of institutions the authors have collected under the rubric "hospitals" it is difficult to accept the authors' decision "not...to study the hospital work of other institutions such as monasteries or great households, nor to consider the whole context of charity in England" (xii). Without tackling the work on charity it is difficult to understand why a history of medieval hospitals is important, or even necessary. For example, the author's point out that hospitals are notable for the degree of local control, (75) but do not discuss the implications this has for the relationship between lay charity and central authority either of church or state. Even closer to their subject as they have defined it, the authors have failed to draw on relevant recent research. For example, their discussion of therapeutics practiced in hospital fails to discuss recent work on non-professional healers and medicinal recipe collections. There is no discussion of hospitals in relation to the concurrent differentiation of medical practitioners and attacks on cleric-physicians. The selection of secondary sources in the bibliography should have been much extended. Detailed research in local archives is no excuse for a failure to adequately survey the work of other historians, particularly for this sort of general overview. In spite of its failure to further debate on larger historical issues, this book is nevertheless a useful reference for anyone interested in describing the characteristics and functions of early English hospitals. Descriptive detail, photographs and other illustrations make it a useful resource for teaching, though establishing the significance of the subject is a project that awaits the attention of future scholars.

Suggestions for further reading:

Lindsay Granshaw and Roy Porter, eds, The Hospital in History (London and New York: Routledge, 1989)

Jonathan Barry and Colin Jones, eds, Medicine and Charity before the Welfare State (London: Routledge, 1991)

Peregrine Horden, "A Discipline of Relevance: The Historiography of the Later Medieval Hospital," Social History of Medicine 1 (1988): 359-74.

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